Friendly face Julia always there for support; Undergoing breast reconstruction can be a mentally and physically traumatic operation. But one Welsh hospital has hired a specialist nurse who guides people through the entire process, as Mark Smith explains.

PATIENTS undergoing breast reconstruction surgery at a Welsh
hospital now have a familiar face offering expert support to guide them
through their treatment.

A pilot project has seen Julia Warwick becoming the first breast
reconstruction nurse specialist in Wales. She's based at Morriston
Hospital's Welsh Centre for Burns and Plastic Surgery and looks
after patients before and after reconstruction surgery.

Julia now has about 200 patients in her care and the number
continues to grow.

Some of them had reconstruction surgery soon after cancer
treatment, for others their operations may have been several years later
or as a preventative measure following genetic testing.

She said: "All of them face the same kind of psychological and
emotional implications surrounding reconstruction.

"They'll make a number of visits to the hospital and will
see me regularly in their initial post-operative period and throughout
their reconstructive pathway."

Julia is the first person new patients see when they are referred
for surgery at Morriston, in Swansea, and she has developed a "meet
and greet" presentation to try to allay some of their initial fears
ahead of their consultation.

"I support them from their first appointment, all the way
through to discharge. Breast reconstruction is a lengthy journey, I am
there to coordinate that journey and support them, to be a friendly face
they can turn to.

"Often they will ask me a question that they wouldn't ask
their consultant."

After working in plastic surgery for more than 23 years, she not
only has expertise in the field, but also good working relationships
with the surgeons who carry out the procedures "This really helps
because you've got that trust so you are able to liaise more
effectively with them.

"It's also about better communication and collaboration
across health boards too, working with other breast teams, making sure
ladies receive primary care in a more efficient way."

Julia sees her job as complementing the role played by breast care
nurses across south and west Wales who look after patients following
their initial cancer diagnosis.

"They do a fantastic job and me having this role means they
can now concentrate on helping patients through their illness and
treatment while I assist with the aspects surrounding reconstruction.
"I can address the more surgical issues following complex breast
reconstruction such as wound management and use my knowledge to reassure
patients."

Since being in post Julia has set up a dedicated phone helpline
operating five days a week from 9am to 5pm for her patients.

"It is being able to pick up a phone and have someone you can
speak to that knows you.

"When patients are discharged, I will always follow up with a
phone call to see how they are feeling and how they are getting on at
home."

Julia explained: "Before I took up this role the patients
would all still have been cared for at their appointments but not
necessarily by the same nurse each time.

"I have been able to offer continuity of care." Someone
who has benefited from that care is mum-of-three Catherine Kirkup, of
Llanwrda in Carmarthenshire.

She had breast reconstruction surgery in April, three years after
her original cancer diagnosis.

She said: "I don't think I would have got through this
without Julia if I'm honest.

"I have had complications and have required three separate
operations. I have had a lot of ups and downs and every time I have come
here Julia has lifted me."

Catherine is still facing further treatment, but says Julia's
guidance has been invaluable.

"Everything I have done has been through Julia; I haven't
had to deal with anyone else. It's nice to come and see the same
person, a friendly face, who knows what she's talking about.

"The consultants have all been really nice but you don't
feel you need bother them about anything because Julia will sort it out
for you, she has all the information that I have needed.

"I've still got a way to go but with Julia it's like
there is someone in your corner.

"She was there the first time I got out of bed after my
operation and has been with me all the way through. I feel like I have
got a new friend."

Consultant plastic surgeon Dai Nguyen, who operated on Catherine,
said: "This pilot post has been an invaluable addition the plastic
surgery breast reconstructive services. "Not only has it improved
the clinical pathway for patients, it has enhanced the patient
experience as women now have a key worker to contact.

"We are extremely lucky to have Julia who is an experienced,
caring and dedicated member of the team. The hope is that this position
will become a permanent post in the near future."

"I love the autonomy it gives me, of being able to do the best
that I can for these ladies under very difficult circumstances and to
support them not only clinically, but also emotionally and
psychologically. "It's all about our patients' experience
and we can only improve services by listening to those patients."

I can address the more surgical issues following complex breast
reconstruction such as wound management and use my knowledge to reassure
patients Julia Warwick

CAPTION(S):

<B Julia Warwick, who works at Swansea's Morriston
Hospital, has become the first breast reconstruction nurse specialist in
Wales. She's pictured with patient Catherine Kirkup

<B Catherine Kirkup says having the support of Julia Warwick has
been invaluable

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